Suicide Prevention by Committee: The VA/DOD Avoid Proper Diagnoses of both the Suicide Epidemic and Brain Wounds

Politics and Rice Bowls are driving a National Suicide Strategy, not Medicine or Health

The government has issued the NATIONAL STRATEGY FOR SUICIDE PREVENTION, 2024 [download here]. They state: “Suicide is an urgent and growing public health crisis. More than 49,000 people in the United States died by suicide in 2022. That’s one death every 11 minutes.” They continue: The 2024 National Strategy for Suicide Prevention is a bold new 10-year, comprehensive, whole-of-society approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide prevention field. This coordinated and comprehensive approach to suicide prevention at the national, state, tribal, local, and territorial levels relies upon critical partnerships across the public and private sectors. People with lived experience are critical to the success of this work. The National Strategy seeks to prevent suicide risk in the first place; identify and support people with increased risk through treatment and crisis intervention; prevent reattempts; promote long-term recovery; and support survivors of suicide loss.‍

There is so much in this Strategy to admire. Better late than never. Sadly, combat and other Veterans figure little in their bold new plan. The Strategy reads more like a cookbook for organizing and communicating and cooperating, a bureaucratic, political document rather than an ops plan for ending suicidal ideation. Rather than a truly revolutionary, root cause analysis of what combat and BLAST and repetitive head hits can lead to, and what Hyperbaric Oxygen Therapy (HBOT) is doing to eliminate suicidal ideation and heal brain wounds, the strategy glances off “treatment” to focus on intercepting and dealing with the suicidal. It’s an updated version of the last decade’s bumper sticker: “If you see something, say something.”

15 Goals and 89 Objectives. We’re going to need Artificial Intelligence to track all those actions and measurements over time, to say not so much about how bureaucratic it all sounds. There is NO QUESTION that the nation needs a Suicide Prevention Strategy with accountability. Government is hard; finding reasons for why people commit suicide is even harder. But failing to use a proven treatment to end suicidal ideation and heal brains — well, that’s negligence. This is deadly serious business, reversing the daily suicide rate. It demands serious, objective people untethered from business-as-usual, dedicated to actually healing brain wounds and whatever other medical conditions are amenable to alternative treatments.

Some will remember the initial rollout of the Affordable Care Act/Obamacare. After letting the Agencies and contractors have their crack at it, the White House decided to get it done right. So they contracted with the pros-from-high-tech and the best insiders to surge a solution. It wasn’t perfect, but it cut through the incompetence and finger-pointing that plagued a real solution. So too with this Suicide Prevention treatment.

One would have thought that after 15-20 years of a suicide epidemic we would have done at least as much to understand more than how to draw an updated wiring diagram of community caregivers and speed up actions that have proved inadequate at effective diagnosis and healing treatment for at least traumatic brain injuries.

It is comforting to read that the VA/DOD Clinical Practice Guideline for the Assessment and Management of Risk for Suicide and the VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT AND REHABILITATION OF POST-ACUTE MILD TRAUMATIC BRAIN INJURY are being updated. It would be better if those CPGs were done by expert outsiders who were up-to-date with the new science, and who were not involved in self-dealing.‍

Clearly we need a plan for dealing with “in extremis” cases, just as we need an “All hands on deck” approach to the epidemic. (One wonders, of course, why it’s twenty years in and we’re still congratulating ourselves for how hard we’re working to bring everyone together?) How woeful and tired can it get? And could they please stop relegating brain-wounded warriors to the “mental health” category until they get properly evaluated for TBI?

There is no sense of URGENCY about Veterans or the daily suicide rate, whatever it is. It’s malignantly bad, whether it’s 16, or 22, or 45 per day for Veterans. This chart above from the VA is enough to show how the plan doesn’t seem to be working.

It’s unsurprising that the plan lacks attention to Veterans, and the need for immediacy for treatment of brain wounds. The Public Sector Chair of the strategy is Dr. Carolyn M. Clancy, MD, Assistant Undersecretary for Health, Discovery, Education and Affiliate Networks (DEAN) U.S. Department of Veterans Affairs. Dr Clancy wrote a scaremongering note to a member of Congress in 2015 that warned of the risks of HBOT, the lack of evidence, etc. The same arguments were regurgitated to Congress last month in almost verbatim form: HBOT is too risky, unproven, too costly, logistically hard, and proven to not work. This is a dereliction of duty on the part of the VA and DOD. They either haven’t kept up with science or they choose to ignore it. (Read the evidence).

As recently as last month, the VA was testifying to the House Veterans Affairs Subcommittee on Health. They gave a failing grade to hyperbaric oxygen therapy as a proven, evidence-based treatment for TBI. Their arguments are ten years old, lacking in understanding of the new science of HBOT-for-TBI, and repetitive in their distortions about risks. [The TreatNOW response to the VA Testimony on a Bill to encourage the VA to use HBOT for TBI is here.]‍

Just read this below for a sense of the wandering in the wilderness quality in the Strategy. It’s a failing grade with respect to treating and healing brain wounds. Suicide Prevention is the #1 clinical priority that the VA and DOD and the nation claim to care about. Yet look at the results issuing from years of work by hundreds of contributors.

STRATEGIC DIRECTION 2: Treatment and Crisis Services. Preventing suicide requires making sure those at risk of suicide get connected to the proper treatment and services they need. Therefore, this strategic direction focuses on the critical importance of implementing a systematic approach to suicide care within health systems, including emphasizing the structural role of the health system in preventing suicide rather than the responsibility resting solely in the hands of individual clinical providers. Additionally, Strategic Direction 2 sets the vision for a complete and coordinated crisis response infrastructure that includes not only a 24/7 nationally available crisis line but also a mobile crisis response, crisis stabilization facilities, and community based alternatives to 911 emergency response.

‍Sift through that and ask: What are you doing differently and what are you going to DO that will make an immediate difference, save lives, save money, and restore health to the warrior and the family? Hundreds of thousands of us? Are we going to be met with the same bushwa using drugs, talk therapy and “mental health” nostrums? Or is the system serious about healing? Healing that reduces need for black-box-labeled drugs and eliminates symptoms rather than masking them under the drug haze?

‍You’ll find no mention of the VA’s own statistics about suicides, and no apology for putting out so much chaff about their “centers of excellence” for TBI and PTSD. Look anywhere in the system they tout as doing so well: Intrepid Center/NICoE, DVBIC, Intrepid Spirit Centers, WRIICs, PREP, Care Coalitions, Wounded Warrior Battalions, and Independent Wellness Centers. Concussion Treatment Centers. The Mayo Clinic, U Penn, UCLA, Langone Center, the Shepherd Center, the Marcus Institute for Brain Health, UPMC Concussion Center. Most of these caregivers really care, but none of them even talk about brain wounds, much less medically approved HBOT for wound healing. What they are good at is all the rest: cognitive, and vestibular, and vision rehabilitation, along with physical therapy and psychotherapy. All of this is good. All may be necessary, but they are insufficient when there is underlying physical damage done to the brain. Heal Brains. Stop Suicides. Restore Lives. TreatNOW.

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The TreatNOW Mission is ending service member suicides. Along the way, we have learned that we can end suicidal ideation, help end symptoms of PTSD, and heal brain wounds to end the effects of BLAST injury, mild TBI Persistent Post Concussive Syndrome, and polytrauma. www.treatnow.org

Heal Brains. Stop Suicides. Restore Lives. TreatNOW

Information provided by TreatNOW.org does not constitute a medical recommendation. It is intended for informational purposes only, and no claims, either real or implied, are being made.